Provider Demographics
NPI:1174580161
Name:BRANCHCOMB, JENNIFER C (ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:BRANCHCOMB
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 LOMBARD CT
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6318
Mailing Address - Country:US
Mailing Address - Phone:954-732-6531
Mailing Address - Fax:
Practice Address - Street 1:6006 LOMBARD CT
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6318
Practice Address - Country:US
Practice Address - Phone:954-732-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 1749174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist